A prospective randomized study comparing fibrin sealant to manual compression for the treatment of anastomotic suture-hole bleeding in expanded polytetrafluoroethylene grafts

Saha, Sibu P.; Muluk, Satish C.; Schenk, Worthington G.; Dennis, James W.; Ploder, Bettina; Grigorian, Alla; Presch, Isabella; Goppelt, Andreas

doi:10.1016/j.jvs.2012.01.009

Cited by 51 publications

(53 citation statements)

References 28 publications

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“…NIHR Journals Library www.journalslibrary.nihr.ac.uk statistically significant reduction in risk of haemorrhage when using fibrin sealants compared with standard care within upper GI tract surgery (six RCTs, 62,74,75,84,85,250 n = 995, OR 0.39, 95% CI 0.19 to 0.80; p = 0.01; I 2 = 0%, fixed-effects model) and no significant difference in the remaining surgical specialties: p = 0.84 (three cardiothoracic lung RCTs, 134,135,205 n = 501), p = 0.69 (two breast RCTs, 99,102 n = 153), p = 0.76 (two vascular RCTs,197,199 n = 339) and p = 0.61 (two eye RCTs, 158,168 n = 80). The random-effects models showed similar results (see Appendix 8).…”

Section: Assessment Of Clinical Effectivenessmentioning

confidence: 99%

“…Haemorrhage was reported in 19 RCTs, of which 17 59,62,74,75,84,85,99,102,134,135,158,168,177,197,199,205,250 (n = 2125) were included in the meta-analysis ( Figure 12). Two RCTs (Neuss et al…”

Section: Haemorrhage (Bleeding)mentioning

confidence: 99%

“…Fibrin adhesives were mostly used to aid haemostasis (five RCTs [188][189][190][191][192] ) and to improve healing. The most commonly reported sealant used was Quixil (spray/glue) and was used in four [193][194][195][196][197][198][199][200][201][202][203][204][205] were identified (Table 10). Fibrin sealant was used in all cases to control suture hole bleeding from placing the graft for vascular access or vascular reconstruction surgery.…”

mentioning

confidence: 99%

“…Fibrin sealant was used in all cases to control suture hole bleeding from placing the graft for vascular access or vascular reconstruction surgery. In [Dacron ® (Ethicon Inc., Somerville, NJ, USA)] grafts were used, whereas in all other RCTs 193,[195][196][197][198][199][200][201][202][203][204] polytetrafluoroethylene grafts were used. These materials are frequently used for vascular replacement or bypass when no autologous venae are available.…”

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confidence: 99%

“…All RCTs used different fibrin sealants apart from the Joseph et al 200 and Czerny et al 205 RCTs that used TachoComb patches. Control group interventions were manual compression 194,[196][197][198]200,204,205 or use of thrombin, 196 thrombin-soaked materials, 196,199 Surgicel 195,196 …”

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confidence: 99%

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The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms

Edwards¹,

Crawford²,

Velthoven³

et al. 2016

Health Technol Assess

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BackgroundFibrin sealants are used in different types of surgery to prevent the accumulation of post-operative fluid (seroma) or blood (haematoma) or to arrest haemorrhage (bleeding). However, there is uncertainty around the benefits and harms of fibrin sealant use.ObjectivesTo systematically review the evidence on the benefits and harms of fibrin sealants in non-emergency surgery in adults.Data sourcesElectronic databases [MEDLINE, EMBASE and The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and the Cochrane Central Register of Controlled Trials)] were searched from inception to May 2015. The websites of regulatory bodies (the Medicines and Healthcare products Regulatory Agency, the European Medicines Agency and the Food and Drug Administration) were also searched to identify evidence of harms.Review methodsThis review included randomised controlled trials (RCTs) and observational studies using any type of fibrin sealant compared with standard care in non-emergency surgery in adults. The primary outcome was risk of developing seroma and haematoma. Only RCTs were used to inform clinical effectiveness and both RCTs and observational studies were used for the assessment of harms related to the use of fibrin sealant. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies. Data extraction was undertaken by one reviewer and validated by a second. The quality of included studies was assessed independently by two reviewers using the Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for Reviews and Dissemination guidance for adverse events for observational studies. A fixed-effects model was used for meta-analysis.ResultsWe included 186 RCTs and eight observational studies across 14 surgical specialties and five reports from the regulatory bodies. Most RCTs were judged to be at an unclear risk of bias. Adverse events were inappropriately reported in observational studies. Meta-analysis across non-emergency surgical specialties did not show a statistically significant difference in the risk of seroma for fibrin sealants versus standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95% confidence interval (CI) 0.68 to 1.04;p = 0.13;I2 = 12.7%], but a statistically significant benefit was found on haematoma development in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86;p = 0.01;I2 = 0%). Adverse events related to fibrin sealant use were reported in 10 RCTs and eight observational studies across surgical specialties, and 22 RCTs explicitly stated that there were no adverse events. One RCT reported a single death but no other study reported mortality or any serious adverse events. Five regulatory body reports noted death from air emboli associated with fibrin sprays.LimitationsIt was not possible to provide a detailed evaluation of individual RCTs in their specific contexts because of the limited resources that were available for this research. In addition, the number of RCTs that were identified made it impractical to conduct independent data extraction by two reviewers in the time available.ConclusionsThe effectiveness of fibrin sealants does not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma. Surgeons should note the potential risk of gas embolism if spray application of fibrin sealants is used and not to exceed the recommended pressure and spraying distance. Future research should be carried out in surgery specialties for which only limited data were found, including neurological, gynaecological, oral and maxillofacial, urology, colorectal and orthopaedics surgery (for any outcome); breast surgery and upper gastrointestinal (development of haematoma); and cardiothoracic heart or lung surgery (reoperation rates). In addition, studies need to use adequate sample sizes, to blind participants and outcome assessors, and to follow reporting guidelines.Study registrationThis study is registered as PROSPERO CRD42015020710.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Assessment Of Clinical Effectivenessmentioning

confidence: 99%

Section: Haemorrhage (Bleeding)mentioning

confidence: 99%